Abstract: Objective To evaluate the relationship between body compositions and cardiovascular risk factors in overweight and obesity patients. Methods A total of 1341 participants with body mass index（BMI）≥25or 23-25kg/m2 with high waist circumference（≥90cm for males and≥80cm for females）were recruited from the First Affiliated Hospital of Fujian Medical University as the overweight and obese group. 1679 participants with BMI＜25kg/m2 and BMI of 23-25kg/m2 with normal waist circumference（＜90cm for males and ＜80cm for females）were recruited as the non-obese group. Data including age,sex,body height and weight,BMI,systolic/diastolic blood pressure,blood lipids,and blood glucose were collected. Dual-energy X-ray absorptiometry was performed to measure fat and lean tissue mass. Results Correlation of trunk fat/leg fat mass（TF/LF）with cardiovascular risk factors was stronger than with body fat content（BF/mass）or trunk fat content（TF/mass）（r=0.291,-0.078 and 0.047,respectively）. Receiver operating characteristic（ROC）curve analyses indicated that the cutoff values of BMI and TF/LF were 26.03kg/m2 and 2.09,respectively,and the predictive capability of TF/LF was higher than that of BMI（area under the curve or AUC:0.684±0.016 vs 0.628±0.017,P＜0.01）. Moreover,BMI（OR=1.250;95% CI1.120-1.395）and TF/LF（OR=4.498;95% CI2.818-7.181）were significantly associated with increased cardiovascular risk in overweight and obesity patients,especially for the contribution of TF/LF（b’=0.418）. Compared with patients with BMI＜26.03kg/m2 and TF/LF ＜2.09 simultaneously,the odds of developing cardiovascular risk factors was 2.473（95% CI1.516-4.032）in patients with BMI≥26.03kg/m2 and TF/LF＜2.09,2.915（95% CI 1.823-4.661）in patients with BMI＜26.03kg/m2 and TF/LF≥2.09,and3.894（95% CI 2.250-6.737）in patients with BMI≥26.03kg/m2 and TF/LF≥2.09,respectively,and there was an increasing trend（χ2=108.3;P＜0.01 for trend）. Conclusions TF/LF is a powerful independent predictor for cardiovascular risk factors in overweight and obesity patients. Moving forward from the management of obesity complication,much attention should be placed on its relationship with body composition,especially for body fat distribution,which adds more weight than BMI. It is also recommended to keep the TF/LF of overweight and obesity patients below 2.09.